Determinants of Repeat Colorectal Cancer Screening in a Safety-Net System

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PROJECT SUMMARY AND ABSTRACT Colorectal cancer (CRC) is the second leading cause of cancer death in the United States and has a disproportionate impact on low-income and ethnic minority populations. Screening has been shown to reduce CRC incidence and mortality, but realizing its full benefits depends on recurrent screening at recommended intervals over time, or repeat testing. Annual fecal immunochemical testing (FIT) is the screening modality commonly used in low-resource safety net settings, given significant barriers to accessing colonoscopies that allow less frequent screening. Although suboptimal rates of up-to-date CRC screening have been well documented, less is known about repeat FIT or multi-level factors motivating FIT completion over time, particularly in safety-net settings. Therefore, the purpose of the proposed study is to assess patient, provider, and system level determinants of repeat FIT at a large federally qualified health center (FQHC). This project builds on an established partnership between the Center for Cancer Prevention and Control Research and Kaiser Permanente Center for Health Equity at UCLA and Northeast Valley Health Corporation (NEVHC), a large multi-site FQHC that provides care for predominantly low-income and Latino patients, populations at greatest risk for CRC screening underutilization. Using a mixed-methods approach, our specific aims are to: (1) assess rates and correlates of repeat FIT over a 5-year period among patients with at least one index FIT at a multi-site FQHC, using electronic medical record and administrative data and a clinic-based scan and (2) characterize perspectives on barriers and facilitators of repeat FIT and experiences with clinic procedures for FIT screening, using semi-structured qualitative interviews with patients, providers, and staff at NEVHC. This project makes positive contributions to our understanding about repeat FIT among low-income, ethnic minority populations receiving care in safety-net settings, and modifiable provider practices and clinic procedures as intervention targets. Findings will inform the development of interventions to improve recurrent, guideline-concordant FIT screening in low-resource clinical settings.